Prevalence and Variation of Medical Comorbidities in Oral Surgery Patients: A Retrospective Study at Jazan University.

BACKGROUND An aged population is susceptible to chronic diseases, which impacts oral surgery treatment procedures. This retrospective study aimed to evaluate the incidence of medical comorbidities in 640 oral surgery patients treated at the College of Dentistry, Jazan University. MATERIAL AND METHODS This single-center observational study investigated medical records of outpatients who visited Jazan University Dental College Hospital in a 1-year period (2018-2019). Patients’ clinical and radiographic archives were screened to obtain relevant data. Categorical and continuous variables were expressed in terms of frequency and mean values, respectively. Differences in variables were statistically analyzed using the chi-square goodness of fit and proportional test, with a probability value P≤0.05 considered significant. RESULTS Analysis of 640 patient records included records of 300 men and 340 women who underwent oral surgery, of whom 176 patients (27.5%), including 97 men and 79 women, had medical comorbidities. The most common comorbidities were endocrine disease (7.03%), cardiovascular disease (6.71%), respiratory disease (4.53%), and hematological disorders (3.43%). Individual diseases that showed higher prevalence were diabetes mellitus (4.68%), hypertension (3.43%), bronchial asthma (2.65%), and anemia (1.4%). Differences by sex were observed in many individual disorders. CONCLUSIONS Outpatients in oral surgery clinics presented a significant variance in the incidence of medical comorbidities, among which diabetes and hypertension were most common. A proper case history is the best preventive measure that helps a surgeon avert medical emergencies and post-surgical complications.

Referral pattern of oral and maxillofacial surgery cases in Sudan: A retrospective age-and sex-specific analysis of 3,478 patients over four years.

Oral and maxillofacial surgery (OMFS) is a specialty widening in its scope. An objective analysis of the referral pattern can provide essential information to improve healthcare. This four-year retrospective study was implemented in Khartoum Teaching Dental Hospital. Data (age, sex, diagnosis, and type of treatment) were collected from patient records. Disease frequency, as well as the effect of sex and age, were analyzed for each group. The frequency of treatment types was also assessed. Data were collected from a total of 3,478 patients over the four-year study period. There was a male predominance with the third decade of life being the most common age group. Pathological diseases were the most common (37%) reason for referral, followed by trauma (31%). Temporomandibular joint (TMJ) disorders and dentoalveolar extraction were the least frequently observed. Open reduction and internal fixation (ORIF) was the most commonly performed procedure (28%). These data represent the epidemiology of oral and maxillofacial diseases in Sudan. Given that the third decade of life is the most represented age group, it is beneficial to learn the long-term consequences of these diseases in these young patients and to use modern surgical techniques to improve their lives.

Prevalence of Operated Facial Injury in the Department of Oral and Maxillofacial Surgery of a Tertiary Hospital.

INTRODUCTION: Maxillofacial injury is one of the commonest causes of surgery performed by an oral and maxillofacial surgeon. Socioeconomic conditions, cultural variation, age, and gender affect the etiology of the injury. The study is aimed to find the prevalence of facial injury that is operated by the oral and maxillofacial surgeons in the College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, a tertiary hospital. METHODS: A descriptive cross-sectional study was performed using the chart from the hospital registry for the patient being operated under general anesthesia from April 1, 2017, to March 2019. Simple random sampling was done using computer-generated random numbers. Ethical approval was received from the Institutional Review Committee of the hospital. The Data for the reason for surgery, age, age groups etiology, and tissue involvement were analyzed using Statistical Package for the Social Sciences version 20. RESULTS: Facial injury occupies 378 (71.59%) of the total operation performed by Oral and Maxillofacial surgeon in a tertiary hospital. Soft tissue 196 (52.85%) and facial bone fracture 182 (48.15%) is distributed among the facial injuries. Young adults are commonly affected, and the road traffic accident is the major cause of facial trauma. CONCLUSIONS: Facial injury-related surgeries are more prevalent in the tertiary hospital of Bharatpur.

Bibliometric analysis and evaluation of the journal Medicina Oral Patología Oral y Cirugía Bucal (2008-2018)

BACKGROUND: In 2008 the journal Medicina Oral Patología Oral y Cirugía Bucal was included in Journal Citation Reports. To appraise its evolution and current status, this study carried out a bibliometric analysis and evaluation of the journal for the period 2008-2018. MATERIAL AND METHODS: From the Web of Science, Journal Citation Reports we obtained the indicators Journal Impact Factor (JIF), 5-year JIF, JIF without self-cites, Eigenfactor score and Article Influence score (2010-2017); and from the Core Collection database the following variables: number and article types, institutions and countries of origin of the authors (2008-2018), and the variable cited and citing journal data in 2017. Twelve articles/year (n = 132) were randomly selected to gather: the time between submittal and acceptance of an article, number of authors/article, representation of each section, gender of first author, and funding. RESULTS: The journal occupied the third quartile of the JCR from 2010 to 2017, when it moved up to the second quartile. From 2008 to 2018 it published a total of 1,518 documents, 90% articles and 9.5% reviews. Sixty countries were represented, 48.68% of the documents coming from Spain, and overall 1,293 institutions were involved. Between submittal and acceptance of articles, the average time was 134.42 days, without differences between years. The mean of authors/article was 5.15, increasing over time. The sections most represented were Oral Medicine and Pathology, and Oral Surgery. There were no differences regarding the gender of the first author, and in general the authors did not provide information about funding received. CONCLUSIONS: The bibliometric results indicate a steadily improving position of this journal, along with a tendency to reduce self-citation. The time between reception of an article and its acceptance was very stable, the number of authors per article showed an increase, and there was a nearly equal representation of males and females as the first autor

No disponible

An Examination of Medical Malpractice Claims Involving Physician Trainees.

PURPOSE: To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events. METHOD: The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events. They classified claims as controls if they were from the same facilities, but trainees were not directly involved in the harm events. They performed multivariable regression with predictor variables being patient and provider characteristics. The outcome was physician trainee involvement in harm events. RESULTS: From the original pool of 30,973 claims, there were 581 cases and 2,610 controls. The majority of cases involved residents (471, 81%). Cases had a statistically significant higher rate of having a trainee named as defendants than controls (184, 32% vs 233, 9%; P < .001). The most common final diagnosis for cases was puncture or laceration during surgery (62, 11%). Inadequate supervision was a contributing factor in 140 (24%) cases overall, with the majority (104, 74%) of these claims being procedure related. Multivariable regression analysis revealed that trainees were most likely to be involved in harm events in specialties such as oral surgery/dentistry and obstetrics-gynecology (OR = 7.99, 95% CI 2.93, 21.83 and OR = 1.85, 95% CI 1.24, 2.66, respectively), when performing procedures (OR = 1.58, 95% CI 1.27, 1.96), or when delivering care in the emergency room (OR = 1.65, 95% CI 1.43, 1.91). CONCLUSIONS: Among claims involving physician trainees, procedures were common and often associated with inadequate supervision. Training directors of surgical specialties can use this information to improve resident supervision policies. The goal is to reduce the likelihood of future harm events.

Anxiety and dental treatments in a hospital in Lima, Peru / Ansiedad y tratamientos dentales en un hospital de Lima, Perú

Background: The dental treatment anxiety affects patient care consultation, regardless of the dental specialty, each with own treatment acts. Objective: To determine the anxiety level of dental treatment of operative dentistry and oral surgery in a hospital of Lima. Methods: The study was conducted in the specialties of operative dentistry and oral surgery, with 72 patients from each specialty, chosen at random over a period of five months, through their answers at Beck Anxiety Inventory. Results: The level of anxiety of patients was similar in the two specialties (p = 0.402). No statistical significant difference was found between anxiety and the patient's sex (p = 0.06), nor with the age of the patient (p = 0.08), nor with the sex of the operator (p = 0.521). The higher frequency of anxiety was the minimum level, 86.1% in operative dentistry and 79.2% in oral surgery. A difference was found between anxiety levels of patients from each specialty (p < 0.001). Conclusions: The frequency of anxiety before entering the specialty was similar, minimum level. Other research is required to determine whether the degree of anxiety is related to the patient's care to dental specialties services.

Introducción: la ansiedad ante un tratamiento odontológico repercute en la asistencia de los pacientes a consulta, independientemente de la especialidad odontológica, cada una con actos propios de tratamiento. Objetivo: determinar el nivel de ansiedad ante el tratamiento de operatoria dental y de cirugía bucal en un hospital de Lima, Perú. Métodos: el estudio fue realizado en las especialidades de operatoria dental y cirugía bucal, con 72 pacientes de cada especialidad, elegidos de manera aleatoria durante un periodo de cinco meses, quienes respondieron el Inventario de Ansiedad de Beck. Resultados: el nivel de ansiedad de los pacientes fue similar en las dos especialidades (p = 0.402). No hubo diferencias entre ansiedad y sexo del paciente (p = 0.06), entre ansiedad y la edad del paciente (p = 0.08), y tampoco con el sexo del operador (p = 0.521). El nivel de ansiedad predominante en todos los pacientes, fue mínimo, 86.1% en operatoria dental y 79.2% en cirugía bucal. Al comparar por separado los niveles de ansiedad de los pacientes de cada especialidad, hubo diferencias en cada caso (p < 0.001). Conclusiones: el nivel de ansiedad antes de entrar a la especialidad de operatoria dental y cirugía bucal fue similar, mínimo. Se deben realizar otras investigaciones para establecer si el grado de ansiedad se relaciona con la asistencia del paciente a los servicios de especialidades odontológicas.

[Dental and oral surgical treatment of the mentally retarded in Hungary: the situation in the past, currently and hopes for the future]. / A szellemi fogyatékosok fogászati-szájsebészeti ellátásának múltja, jelene és remélt jövoje Magyarországon.

Introduction: Dental care for mentally disabled people poses a growing challenge for healthcare. In Hungary, the number of mentally disabled people needing special dental care is ca. 100 000. Aim: The aim of our retrospective analysis is to provide a summary of the demographic data and the treatment outcomes of patients with mental disorders treated at the Department of the Oral and Maxillofacial Surgery of the Semmelweis University in the past five years. Method: Dental care for patients with a severe level of mental disability can be carried out in general anaesthesia only. At Semmelweis University, in the Oral and Maxillofacial Department, 1717 mentally disabled adults received dental care during the past five years. (Patients included people with a mild, medium or severe level of mental disability, patients with Down's syndrome, autism, epilepsy or panic disorder.) Results: The single biggest achievement seems to be the fact that the issue of acute dental care and oral surgery has basically been settled. A workable relationship has been forged with foundations and organizations dealing with the problems of these patients. It has been realized, however, that in the case of mentally disabled patients there is an enormous need for prevention and ongoing care. Conclusions: Up to now no survey has been carried out in Hungary with the aim of objectively revealing the dental care needs of these patients. Internationally, however, several surveys have been published. It can be stated on the basis of these that both caries frequency and the presence of parodontal diseases increase in correlation with age and the level of disability. Oral hygiene is insufficient, patients or their caretakers do not get proper information, only a few of them receive adequate training and they are not motivated to keep up oral health. Dental care, except for tending acute cases, is not satisfactory. For the sake of prevention, cooperation is needed with non-governmental organizations, foundations, special education teachers and psychiatrists specialized in this field. Orv Hetil. 2019; 160(35): 1380-1386.

Perioperative Management in Patients With Undergoing Direct Oral Anticoagulant Therapy in Oral Surgery - A Multicentric Questionnaire Survey.

AIM: The purpose of this study was to survey the current opinions of hospitals and medical practices concerning the perioperative management of patients undergoing direct oral anticoagulant therapy (DOAC) and discuss recommendations for the clinical practice. MATERIALS AND METHODS: A questionnaire with 13 topics and multiple ordinal-polytomous subitems was designed and sent to 120 Departments of Oral and Maxillofacial Surgery in Austria, Switzerland and Germany, as well as to 85 oral and maxillofacial/oral surgeons in medical offices in Hamburg, Germany. The data were statistically evaluated by Chi-square, Fisher's exact and Jonckheere-Terpstra tests. RESULTS: The rate of response was 42%. Thirty-seven percent of respondents reported treating over 50 patients per year with undergoing DOAC therapy and only 18% assess a high bleeding risk [33% for vitamin K antagonists (VKA)]. In contrast to that, 62% of respondents would interrupt the DOAC therapy for extraction of one tooth, while 94% would continue VKA therapy. Significantly more clinicians apply suture than those in a medical office. The use of additional hemostatic measures varied between clinic and medical practice. There was a clear request for more detailed guidelines. CONCLUSION: The study shows the current opinion for perioperative management of patients undergoing DOAC therapy. Multi-centric studies under controlled conditions are needed for a safer treatment of anticoagulated patients as therapy strategies differ greatly between institutions and therefore a complication analysis is hardly possible.

Citation Network Analysis of Dental Implant Literature from 2007 to 2016.

PURPOSE: This bibliometric study analyzed English language dental implant literature from 2007 to 2016 to evaluate and identify the terms, authors, and journals concerning dental implant articles with high citation count and the structure of their bibliometric networks. MATERIALS AND METHODS: The Web of Science database was searched to identify articles on the topic of dental implants published under the Web of Science category of Dentistry, Oral Surgery & Medicine from 2007 to 2016. The articles were first assessed using descriptive analysis concerning the authors, organizations, countries/territories, and journals. Afterward, VOSviewer was used to visualize the term map, author network, and journal network consisting of the most highly cited entities. CiteSpace II was used with default settings to identify keywords that experienced a large increase in citations received within the surveyed period of time. RESULTS: The citation analyses were based on 12,114 dental implant articles published during the survey period. The top five highly cited terms with > 500 publication counts were peri-implantitis (a mean of 20.17 citations per surveyed article [CPA]), survival rate (19.02 CPA), survival (18.74 CPA), implant failure (16.58 CPA), and success rate (16.53 CPA). The top five authors with highest average citations authored 80 papers (80/12,114 = 0.7%) that received 5,962 citations (5,962/151,404 = 3.9%) among the highly cited authors' network. Clinical Oral Implants Research had the largest total number of citation links (19,283), and hence, was in the center of the journal network, with a mean of 21.47 citations per surveyed article. CONCLUSION: The terms with high impact were related to implant success, survival, failure, and peri-implantitis. Clinical Oral Implants Research and The International Journal of Oral & Maxillofacial Implants were in the center of the journal citation network.

A 5-year audit of major maxillofacial surgeries at Usmanu Danfodiyo university teaching hospital, Nigeria.

BACKGROUND: There is a paucity of data on the pattern of oral and maxillofacial surgeries done in Nigeria. Despite the rising prominence of oral and maxillofacial surgery as a specialty in our immediate environment, no published audit of the surgeries performed exist. This study aims to present the pattern and types of major surgeries done by oral and maxillofacial surgeons in our hospital as well as the indications for such surgeries. It is hoped that the findings will assist in formulating informed policies and improving healthcare delivery. METHODS: A review of hospital records of all patients who had major oral and maxillofacial surgeries at Usmanu Danfodiyo University Teaching Hospital from January, 2013 to August, 2017 was done. Descriptive statistics such biodata, indication for surgery and type of surgery were recorded and analyzed using the IBM SPSS statistics for windows version 20 (Armonk, NY: IBM Corp) software. RESULTS: One hundred and forty six individuals who underwent 158 major surgeries under general anaesthesia were included. There were 82 males and 64 females, giving a male/female ratio of 1.3: 1. The ages ranged from 3 months to 81 years [median of 33 years]. Tumours and tumour-like lesions were the major indications for surgery [85 (58.2%)]. The most commonly performed surgery was mandibulectomy [31 (19.6%)], followed by Open Reduction and Internal Fixation (ORIF) [29 (18.4%)]. CONCLUSION: Major oral and maxillofacial surgeries are common in our environment. The frequencies of these surgeries can increase with better healthcare financing and universal availability of health insurance schemes. Efforts aimed at reducing the incidence of tumours should be instituted.

Awareness of dentists regarding immediate management of dental avulsion: Knowledge, Attitude, and Practice study.

OBJECTIVE: To assess the knowledge of practising dentists regarding immediate management of dental avulsion. METHODS: The cross-sectional analytical study was conducted in various dental colleges and teaching hospitals of Karachi, Pakistan, in October-November 2016, and comprised dentists working in academic institutions / departments or as general dental practitioners for at least 1 year. The subjects were asked to fill out a self-administered questionnaire. Questions related to knowledge and practice regarding immediate management of dental avulsion was asked and then responses were categorised as good knowledge, moderate and poor knowledge. SPSS 22 was used for data analysis.. RESULTS: Of the 282 subjects, 179 (63.5%) were females and 103(36.5%) were males. The overall mean age was 28. 33±4.7 years, and 194 (68.8%) had clinical experience of less than 5 years. Of the total, 30(11%) dentists had good knowledge while 130(46%) had moderate and 122(43%) had poor knowledge. Statistically significant association of knowledge regarding tooth avulsion was observed with the specialty (p= 0.006) and qualification (p=0.001). CONCLUSIONS: The knowledge of dentists regarding immediate management of avulsion injuries was inadequate. Knowledge was significantly associated with specialty and qualification of the dentist.

Current concepts in cleft care: A multicenter analysis.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.

Is a fractured mandible an emergency?

We retrospectively audited the records of 708 patients who presented with the diagnosis of fractured mandible between January 2009 and July 2013 at the Queen Elizabeth Hospital, Birmingham. We assessed the different factors that may have altered their outcomes, and found that delay before definitive fixation caused no harm in either the short or the long term.

Pattern of maxillofacial surgical conditions in North Central Nigeria: A 5-year experience of an indigenous surgical mission.

BACKGROUND: Several publications have presented pattern of maxillofacial surgical conditions based on data from hospital-based studies. The objective of this study is to present the spectrum of maxillofacial surgical conditions from the perspective of a community study. METHODS: This is a prospective study of all patients seen and treated from 2011 to 2016. The information obtained included the biodata, clinical history of the disease conditions, radiological result, histopathologic result, diagnosis, and treatment records. Data analysis was carried out using SPSS version 20.0. RESULTS: There was a total of 863 patients, male 464 (53.8%) and female 399 (46.2%). The male to female sex ratio was 1.16:1. The age range was 3 days to 76 years with a mean age (SD) 16.8 ± 15.8 years. The spectrum of surgical conditions: facial clefts 492(57.0%); tumor and tumor-like lesions 126(15.2%), trauma 6(0.7%), and others 48(5.5 %). The size of tumors ranged from 5 to 50.4 cm2 with a mean (SD) 21.6 ± 11.9 cm2 and the duration of lesion ranged from 1 to 20 years with mean (SD) 8.7 ± 6.0 years. A total of 622(77.4) cases were operated within the study period with immediate jaw reconstruction in 5(0.8%) patients. Minor complications were recorded but there was no mortality. CONCLUSION: The spectrum of maxillofacial surgery from community-based data was associated with higher percentage of facial cleft as compared to hospital-based study that is associated with higher traumatic injury cases. High level of poverty, ignorance, and poor access to maxillofacial service have been identified as shortcomings in the management of the diseases. There is a need for pragmatic move to improve facility, training, enlightenment, and more funding of outreach programs.

African Americans in Oral and Maxillofacial Surgery: Factors Affecting Career Choice, Satisfaction, and Practice Patterns.

PURPOSE: There are few data available on the experience of minority surgeons in the field of oral and maxillofacial surgery (OMS). Therefore, the purpose of this study was to 1) explore factors that contribute to African Americans choosing OMS as a career, 2) examine satisfaction among minority oral and maxillofacial surgeons with the residency application and training process, 3) report on practice patterns among minority oral and maxillofacial surgeons, and 4) identify perceived bias for or against minority oral and maxillofacial surgeons in an attempt to aid the efforts of OMS residency organizations to foster diversity. MATERIALS AND METHODS: A 19-item survey was sent to 80 OMS practitioners by use of information from the mailing list of the National Society of Oral and Maxillofacial Surgeons, an American Association of Oral and Maxillofacial Surgeons-affiliated organization. All surveys were sent by mail and were followed by a reminder mailing after 8 weeks. Responses returned within 16 weeks were accepted for analysis. RESULTS: Of the 80 mailed surveys, 41 were returned within the 16-week parameter, representing a return rate of 51%. Most of the minority surgeon respondents were married men with a mean age of 60 years who worked as private practitioners. Most respondents practiced on the eastern and western coasts of the United States. Exposure in dental school was the most important factor in selecting OMS as a specialty. Location and prestige were the most important factors in selecting a residency program. Most respondents reported that race did not affect the success of their application to a residency program and did not currently affect the success of their practice. However, 25 to 46% of participants experienced race-related harassment, and 48 to 55% of participants believed there was a bias against African Americans in OMS. CONCLUSIONS: Our data suggest that a substantial number of minority oral and maxillofacial surgeons subjectively perceive race-based bias in their career, although it does not appear to affect professional success.

Epidemiología de la patología quirúrgica que afecta al territorio maxilofacial, tratada bajo anestesia general en el Hospital de Urgencia Asistencia Pública entre 2014 y 2016 / Epidemiology of surgical pathology affecting the maxillofacial area, treated under general anesthesia at the Emergency Hospital Public Assistance between 2014 and 2016

Objetivo: Presentar la experiencia de la especialidad en cirugía y traumatología bucal y maxilofacial en el Hospital de Urgencia Asistencia Pública, a través de la epidemiología de los tratamientos quirúrgicos realizados en pabellón central, bajo anestesia general, durante el período comprendido entre noviembre del 2014 y julio del 2016. Material y métodos: Se realizó un estudio retrospectivo en el que se analizaron los protocolos operatorios de los pacientes intervenidos durante el período. Se recopiló información de la base de datos del pabellón central sobre el diagnóstico, la edad, el sexo y el tipo de procedimiento quirúrgico. Se incluyeron 125 procedimientos quirúrgicos realizados en 109 pacientes. Resultados: La edad promedio de los pacientes intervenidos fue de 38 años, con preponderancia del sexo masculino (70,6%). El 50,4% de los procedimientos quirúrgicos correspondieron a traumatismos en el territorio maxilofacial, de los cuales la fractura mandibular fue la lesión más frecuente (68,3%). El 46,4% de los procedimientos correspondieron a infecciones en el territorio maxilofacial, en los cuales la localización más frecuente fue el espacio anatómico submandibular (25,8%). El resto de los procedimientos se relacionó con otro tipo de diagnósticos (3,2%). Discusión: En general los resultados concuerdan con estudios similares realizados en hospitales de atención de urgencia. Conclusión: Dentro de las patologías de urgencia del territorio maxilofacial, las lesiones traumáticas e infecciones son las que con mayor frecuencia requieren de cirugía mayor bajo anestesia general. Los pacientes intervenidos con cirugía bajo anestesia general en pabellón central son principalmente hombres, siendo las fracturas mandibulares y la infección del espacio submandibular las lesiones más frecuentes en cada tipo de patología.

Objective: To determine the experience of the specialty in Oral and Maxillofacial Surgery and Traumatology at the Hospital Emergency Assistance Publique, through epidemiology of surgical treatments carried out in major operating room, under general anesthesia during the period between November 2014 and July 2016. Material and methods: A retrospective study where the operative protocols of patients operated during the period analyzed was performed. Database information from major operating room for diagnosis, age, sex and type of surgical procedures was collected. 125 surgical procedures performed in 109 patients were included. Results: The average age of the operated patients was 38 years with a preponderance of males (70.6%); 50.4% of surgical procedures were for injuries in the maxillofacial area, where the mandibular fracture was the most common lesion (68.3%); 46.4% of the procedures were for infections in maxillofacial area, where the most common location was the submandibular anatomical space (25.8%). The rest of the procedures related to other diseases (3.2%). Discussion: In general the results are consistent with similar studies in emergency care hospitals. Conclusion: Within the pathologies of urgency of the maxillofacial territory, traumatic injuries and infections are those that most frequently require major surgery under general anesthesia. Patients undergoing surgery under general anesthesia in major operating room are mainly men, with mandibular fractures and submandibular space infections being the most frequent lesions in each type of pathology.

Cirugía y traumatología bucomáxilofacial en la red hospitalaria chilena / Maxilofacial surgery in the Chilean healthcare network

RESUMEN: Argumentando la existencia de listas de espera de cirugía bucal y máxilofacial, los Ministerios de Salud y Educación chilenos deciden crear un profesional de menores competencias que el cirujano bucal y máxilofacial existente, cuya formación dure un año y se desempeñe en la atención primaria de salud. Decretan la especialidad de Cirugía Bucal, comprometiendo la calidad y seguridad de la atención, exponiendo a los enfermos a eventos adversos de impredecibles desenlaces, afectando la calidad de vida de éstos o provocando eventualmente un desenlace fatal. El objetivo del presente estudio es establecer el número de cirujanos bucales y máxilofaciales formados en el país, conocer cuantos se desempeñan en hospitales públicos y su distribución en los servicios de salud, así como también evaluar si se cumplen las condiciones de infraestructura necesarias para desarrollar la especialidad según la normativa vigente. Consideramos que éstos son datos fundamentales al momento de modificar políticas públicas. La metodología propuesta es un estudio descriptivo de corte transversal, realizando una encuesta dirigida a los jefes de los servicios odontológicos de la red hospitalaria pública del país, destinada a obtener información del prestador individual e institucional en cada centro de la red. Se concluye que existe una cantidad suficiente de especialistas formados y en vías de formación para atender las necesidades de la población. La evidencia muestra que faltan cargos e infraestructura, por lo que la medida adoptada por el MINSAL respecto a la creación de la especialidad de Cirugía Bucal obedece a un error diagnóstico desde el punto de vista del prestador individual e institucional, originado por la ausencia de un estudio técnico que evalúe la red hospitalaria del país.

ABSTRACT: Arguing the existence of waiting lists in oral and maxillofacial surgery, the chilean Ministries of Health and Education decided to create a professional less skilled than the existing oral and maxilofacial surgeon, whose training lasts one year and works in primary care health. They established the specialty of Oral Surgery, compromising the quality and safety of care, exposing patients to adverse events with unpredictable outcomes, affecting their quality of life or eventually causing a fatal outcome. At the time of this study there is no record of the number of oral and maxillofacial surgeons trained in our country, it is unknown how many are working in public hospitals and their distribution in health services, as well as whether there is the necessary infrastructure to develop the specialty under current regulations. We made a descriptive transversal study, conducting an interview aimed to obtain information from individual and institutional providers to know the reality of the specialty in the public health network. It is concluded that there is a sufficient number of specialists trained and in training to meet the needs of the population. The evidence shows missing possitions and infrastructure, so that the action taken by the Health Ministry regarding the creation of the specialty of Oral Surgery is due to a misdiagnosis from the point of view of an individual and institutional provider, caused by the absence of a technical study to assess the country’s hospital network.

Is Treating Oral and Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center.

PURPOSE: During the past 2 decades, there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. Although many factors can influence the decision not to take trauma call, 1 primary disincentive is the perception that managing facial trauma might be profitable for the hospital, but not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the Virginia Commonwealth University (VCU) Medical Center (Richmond, VA). MATERIALS AND METHODS: In this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery at VCU (VCUOMS) from June 2011 through July 2014. Cost and reimbursement data were analyzed for these patients from the VCU Health System (VCUHS) and the VCUOMS. For the hospital, actual cost data were provided; for the surgeon, cost was calculated based on an average overhead of 50%. For uniformity, patients were excluded if they remained in the hospital for longer than a 23-hour observation period. Patients younger than 18 years also were excluded. RESULTS: In total, 169 patients met the inclusion criteria. There was a statistically relevant difference in the percentage of costs recouped and the actual profit. The average percentage of costs recouped was 230% for the VCUHS versus 47% for the VCUOMS. This amounts to an average profit per case of $3,461 for the hospital versus a loss of $1,162 for the surgeon. CONCLUSIONS: The results of this study indicate that in the VCU Medical Center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. Although the results are limited to outpatient management at 1 academic institution, they suggest that hospitals in some settings might be in a position to incentivize surgeons for trauma management.

Oral surgery in the European Union: challenges of diversity in training and practice.

INTRODUCTION: At the crossroads of medicine and dentistry, oral surgery with orthodontics are the only recognised dental specialties by the European Union. The goal of our study is to evaluate the current state of oral surgery in Europe from its teaching to its practice, the hypothesis being that a notable diversity persists despite European Union harmonisation process. MATERIALS AND METHODS: To understand the impact of this diversity applied to European Union freedom of movement and its ethical implications for the practice of oral surgery, English and French questionnaires were sent by email to universities and organisations delivering authorisation to practise in France, Germany, Spain, Sweden and United Kingdom chosen based upon inclusion and exclusion criteria. An analysis of documents on these organisations' official websites was also conducted. Demographic information was obtained from the aforementioned organisations. RESULTS: The profile of practising oral surgeons is different dependent on the country. The university and hospital trainings conform to European recommendations and span 3-4 years. European Board certification is not required. Continuing education is mandatory only in France, Germany and United Kingdom. As for curricula and scope of practice, no consensus can be derived. DISCUSSION: There is potential conflict of interest between European Union principles of freedom of movement and protection of all citizens, as member countries do not uniformly apply Directives and recommendations. A new survey of all European Union oral surgery programmes as well as organisations delivering authorisation to practise is necessary to implement across the board harmonisation of training and practice to insure patient safety in light of the migration of European Union practitioners.